Leukaemia Flashcards
How are Haematological malignancies classified?
=> Acute Myeloid Disorders:
- Acute Myeloid Leukaemia
=> Acute Lymphoid Disorders:
- Acute Lymphoblastic Leukaemia
=> Chronic Myeloid Disorders:
- Chronic Myeloid Leukaemia
- Myeloproliferative Neoplasma
- Myelodysplastic Syndrome
=> Chronic Lymphoid Disorders:
- Chronic Lymphocytic Leukaemia
- Non Hodgkins Lymphoma
- Hodgkins Lymphoma
- Myeloma
What is Leukaemia?
A generic term used for the cancer of white blood cells
What cells arise from the myeloid lineage?
=> Granulocytic cells:
- Eosinophils
- Basophils
- Neutrophils
- Monocytes
- Erythrocytes
- Mast cells
- Platelets
What cells arise from the lymphoid lineage?
- B Cells
- T Cells
- Natural Killer Cells
- Plasma Cells
What is the pathophysiology of Leukaemia?
- Genetic mutations of haematopoetic stem cells or early progenitor cells
- Clonal expansion of these abnormal cells due to survival or proliferative advantage
- Accumulation of these cells leads to transformation to leukaemia
In what gender is Acute Myeloid Leukaemia most prevalent?
- Male
- Most common form of acute leukaemia
What is the pathophysiology of Acute Myeloid Leukaemia?
- Proliferation and arrested maturation of myeloid blast cells in the bone marrow
- These cells accumulate in the bone marrow, resulting in bone marrow failure as there is less space for normal cells
From what conditions may Acute Myeloid Leukaemia arise from?
- Myelodysplastic Syndrome
- Myeloprolifertaive Neoplasm
- Chronic Myeloid Leukaemia
What are the clinical features of Acute Myeloid Leukaemia?
As a result of anaemia => pallor, lethargy, weakness
As a result of neutropenia => frequent infections
As a result of thrombocytopenia => bleeding
As a result of metastasis => organmegaly, gum hypertrophy, skin involvement
What are the investigations in suspected Acute Myeloid Leukaemia?
=> Bloods
- Thrombocytoenia and Neutropenia due to arrest of maturation. WCC may be raised, normal or low, therefore bloods are not a definitive diagnosis tool
=> Peripheral blood smear
Auer rod in myeloid blast cells only seen in AML
=> Bone Marrow Biopsy
What is the management of Acute Myeloid Leukaemia?
- Prophylactic treatment of infection
- Supportive care
- Chemotherapy: Anthracycline, Cytarabine
- Bone Marrow Transplant
What is Acute Lymphoblastic Leukaemia?
- Most common malignancy in children
- Accumulation of lymphoid blast cells which were meant to mature into B and T cells
What are the clinical features of Acute Lymphoblastic Leukaemia?
=> May see Bone Marrow Failure:
Due to anaemia => pallor, lethargy
Due to neutropenia => frequent or severe infections
Due to thrombocytopenia => easy bleeding and bruising
=> Other features due to infiltration:
- Bone pain
- Hepatosplenomegaly
- Fever
- Testicular swelling
Thrombocytopenia, Neutropenia and anaemia is seen due to the build up of these mutated immature myeloblast or lymphoblast (in this case) cells in the bone marrow, causing normal cell death as the abnormal cells compete with normal cells for nutrients.
=> WCC MAY be raised
What are the investigations in suspected Acute Lymphoblastic Leukaemia?
=> Bloods
- Lymphoid markers help differentiate from AML
=> Serum electrolytes
Elevated Ca, PO4, K, uric acid, lactic acid
What is the management of Acute Lymphoblastic Leukaemia?
- Supportive
- IV antibiotics for prophylaxis
- Chemo for 2-3 years, Intrathecal methotrexate
- Bone marrow transplant
What is the pathophysiology of Chronic Myeloid Leukaemia?
=> Philidelphia chromisome
- Translocation between the long arms of chromosomes 9 and 22
- ABL-protoncogene on chromosome 9 fuses with BCR gene from chromosome 22
- BCR-ABL gene codes for a fusion protein which causes overactivity in tyrosine kinase
What are the clinical features of Chronic Myeloid Leukaemia?
- Anaemia
- Weight loss and sweating
- Splenomegaly - may cause abdominal discomfort
- Increase in granulocytes at different stages of maturation
What are the investigations in suspected Chronic Myeloid Leukaemia?
=> Bone Marrow Biopsy
- Granulocytic hyperplasia. Increased in number of partially mature granulocytes
=> Bloods and blood smear:
- Hb and platelets may be normal or reduced
- Possible increase in number of granulocytes
- Pseudo Palger Huet cells
=> Chromosomal analysis - FISH
- Philidelphia chromsome
What is the management of Chronic Myeloid Leukaemia?
1st line treatment => Inatinib
- Considered for stem cell transplant
What is Chronic Lymphocytic Leukaemia?
Caused by monoclonal proliferation of functionally incompetent lymphocytes,
- Most common form of leukaemia in elderly
How are the Chronic Leukaemias different from the Acute Leukaemias?
Chronic Leukaemias see rise in partially mature blood cells where as Acute Leukaemias the process of maturation stops. Both types may see varying degrees of cytopenia
What are the clinical features of Chronic Lymphocytic Leukaemia?
- Anorexia, weight loss
- Bleeding
- Infections
- Lymphadenopathy more marked
=> Often asymptomatic
What staging system is used for Chronic Lymphocytic Leukaemia?
Rai Staging
I - Lymphocytosis alone
II - Lymphocytosis + lymphadenoapthy
III - Lymphocytosis + organmegaly
IV - Lymphocytosis + (platelets < 100 x 10^9)
What are the complications of Chronic Lymphocytic Leukaemia?
- Anaemia
- Hypogammaglobinaemia
- Autoimmune haemolytic anaemia
- Transformation to high grade lymphoma (Non-Hodgkin’s Lymphoma)
